Category Archives: hip

Last month I saw a great video posted by Bret Contreras showing a variation on a bodyweight glute bridge that very effectively targets the glutes. The reason it’s effective is that he basically fires up the whole body in a manner that prevents some of the typical “cheats” that people often do when trying to do glute bridges.

While glute bridges seem like an easy exercise (lie on your back, lift your butt up. how hard can it be?), the reality for many is that they feel glute bridges everywhere but their butt. When I ask clients where they feel a glute bridge, I often get some combination of hamstrings, back, quads, and abs. This is not everyone – some people do glute bridges and feel their glutes – but it is more than the minority.

This glute bridge with frog pumps that Bret posted struck me as a great option, so I gave it a try. And it was indeed a great option. Check it out here.

Essentially it’s a glute bridge but with feet flat against each other, flatten the lumbar spine, push the elbows into the floor, and bring the chin to the chest.

I did like it, but I opted for two minor changes:
- instead of chin to chest, I went for a neutral neck alignment, which looks like a packed neck, or what I call “ugly neck”. Take a look at my chins in the video and you’ll see why I call it ugly neck. I opted for this because I know some of my clients would have a hard time with holding the chin to chest position.
- Instead of feet flat, I went for feet angled to each other. Many people will be fine with the feet together position, but I personally found it irritating for my hips as I don’t have great hip mobility. I also have a few clients whose knees didn’t like the feet together position. So the angled feet position was a nice alternative for those with either hip or knee stuff.

Here’s a video of this modification:

If you find you have a hard time feeling your glutes when you do do glute bridges, try out Bret’s variation instead, and if your neck, knees, or hips don’t love that variation then try my variation to the variation.

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FAI, or femoro acetabular impingement, is a hip “abnormality” in the shape of either or both of the femoral head and acetabulum. If you have it, or suspect you have it, you’re probably relatively young (seemingly too young for hip problems), and you’ve probably been dealing with hip and/or groin pain for a while without knowing what was going on, until someone finally came up with FAI.

I was diagnosed with it in 2007 after almost two decades of on-again, off-again hip pain and dysfunction. Since then, I’ve read a lot, chatted with many people who have it, and have trained many clients with it. I recently wrote briefly about my own experience with FAI, and have also written an at-home exercise ebook for FAI.

As more is known about FAI, more research is being published. I’ve pulled out five particularly interesting facts (or so I think) from the research, and have included my interpretation of them and their potential relevance. Enjoy, and please ask questions in the comments and I’ll get to them as soon as I can. One note: use of the term “young” in this post refers to people under the age of fifty. Funny how our concept of “young” changes as we age! With respect to hips and FAI, studies tend to focus on people under fifty.

Fact #1: FAI is much more prevalent among men than women, with studies suggesting anywhere from 14% to 24% occurrence in young men with asymptomatic hips , but only 6% in young women with asymptomatic hips.[1]Interpretation: FAI is a real thing, even among people with no symptoms. The question is, what does it mean? If someone has FAI but has no symptoms, should we do anything about it? Take my hips for instance. I had twenty years of hip pain in my left hip, and zero years of pain in my right hip, but I have FAI in both. My sense as a trainer is that it’s important to recognize that not all hips are built “to spec” and that the two biggest areas where we should keep FAI in mind are in relation to stretching and squats. With hip stretches, I keep tabs on whether it causes pain or discomfort. If it does, I’m going to tend to assume we’re pushing into a bony end range (maybe FAI; maybe another hip structural anomaly), and I’m going to back off that stretch. I’ll talk about squats down a few facts.

Fact #2: FAI is twice as common among men with limited hip internal rotation as those with normal hip rotation range of motion.[2]Interpretation: I think an important question to ask about this finding is whether FAI is more common in the presence of reduced internal hip rotation, or whether reduced internal hip rotation is an early sign of FAI. Either way, I think the take home is similar to the take home for fact#1: If someone has limited hip internal rotation, there might be a structural contribution, so be careful with your efforts to increase internal rotation range of motion. In fact this might be a situation where seeking input from a good physical therapist, athletic therapist, or chiropractor would be in order.

Fact #3: “We performed a database review of pelvic and hip radiographs obtained from 157 young (mean age 32 years; range, 18-50 years) patients presenting with hip-related complaints to primary care and orthopaedic clinics…At least one finding of FAI was found in 135 of the 155 patients (87%)”[3]Interpretation: Yikes! 87% of young, symptomatic hips had FAI? I think the take home here is obvious: Don’t ignore comments of hip pain. Perhaps this is a good reminder that the body is pretty good at telling us when something is wrong, if we’re willing to listen. I always hate to suggest this, but feel I would be remiss if I didn’t: If your hip hurts after you play your chosen sport, maybe you should question whether playing that sport is appropriate for you? That’s not to say that if something hurts a bit, you should stop playing. Definitely not! But if your hip constantly hurts during or after a specific activity, despite having spent months (or years in my case) with a manual therapist and a good training program, maybe your body isn’t built to do that activity. For me, this brings a flashback to the 2007 Canadian Ultimate Championships, and me sitting in the stands between games with a big bag of ice on my left hip while snacking on vitamin I (Advil). Note I did this “in between games”; not after stopping playing because my body was clearly telling me that I was damaging my hip. So yes, this is me suggesting you aim to be smarter than I was.

Fact #4: People with FAI have less range of motion in body weight squats than do people without FAI.[4]Interpretation: People who have FAI probably shouldn’t squat. How can you tell? Is it painful? Does your pelvis shift to one side during the squat? Do you start to round your back at the bottom? These are signs that you lack the range of motion or stability required to squat so your body is finding alternative ways. If you see this, try to fix it, and if you can, great. But if you can’t fix it, then you are probably someone who shouldn’t squat. Thankfully it is possible to be awesome without squats in your workout.

Fact #5: Hockey players have a higher prevalence of FAI than do skiers and soccer players, and the rate increases as they move up, with particularly high levels noted at the midget level.[5]Interpretation: FAI might be something people develop in response to biomechanical forces? And it would appear that there is something in the way hockey players skate that produces higher rates of adaptation. It would be interesting to see if similar numbers are seen in figure skaters, to see if it is a skating thing, or if it is a skating with the torso in a flexed position thing? In terms of what I suggest, I need to disclose that I have a conflict of interest: I am Canadian. And that means I can’t suggest that someone consider not playing hockey, because I don’t want to have my passport revoked. But you may want to re-read fact #3.

If you have FAI, are you a hockey player? How’s your hip internal rotation? How does your squat look? Do squats cause hip pain? Do you keep doing them anyway? It’s interesting to think that our bones change in response to our activities. That may seem revolutionary, but in fact it’s a long-known truth. In fact it’s even got a name: Wolff’s Law.

I’m very excited to be launching my new ebook: Training Around Injuries: At Home Exercises for FAI in November.

Did I mention that I wrote an FAI ebook? Head over here to learn more (and to buy it). It’s a home exercise program (4 of them actually), complete with photos and instructions, a link to a video playlist that has all 42 exercises demonstrated and described, and a background section to help you understand what might be going on.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa Canada who also has FAI (technically I had it on both sides but after surgery on the left, I now only have it on the right).

Lots of people foam roll, but I’ve noticed not many seem to roll their adductors (groin). It’s too bad, because I notice that when I show this to my clients at Custom Strength, that it is very clear many of them need it. Ideally, these people would also be getting manual therapy on their adductors as well, but let’s start with the easier solution, and show you a video about how to roll the adductors. It’s one of the 40+ exercise videos that is included in my upcoming Training Around Injuries: Home Exercises for Femoro Acetabular Impingement (FAI) ebook.

The reason I’m sharing this exercise now is that a friend of mine mentioned this evening that she is having some adductor pain, that started with a pull in a game (ultimate) a couple of weeks ago. She noted it had been better but then was acting up again. I suggested seeing her massage therapist (although manual therapist – which would include physio, athletic therapist, and chiropractor would have been a better suggestion). I also suggested rest and stretching may be good options, and then went on to talk about the “why”. Just a quick note: I’m not by any means qualified to give advice about how to fix a groin strain: that’s what manual therapists and sports medicine doctors do. But I do have opinions (one of which is to see a manual therapist), and so I shared them (including the ‘go see a manual therapist’ part). Note how many times I mention ‘ see a manual therapist’ in this paragraph? By all means please do read on and do watch the foam rolling the groin video, but what’s the real best option to do when you have some unknown groin injury? Hint: go see a manual therapist or sports medicine doctor.

Health care recommendations aside, I am an exercise nerd, so of course, I also talked about why this may have happened. Now I don’t haven any idea how she moves (other than being a great ultimate player), so it really could be anything. But it made me think of a great blog article by Michael Boyle called “Understanding Sports Hernia May Mean Understanding Adduction“. You really should read it, because it’s a fantastic article, especially if you’re in the strength and conditioning or physio realm.

Coach Boyle notes that two of the five adductor muscles (pectineus and adductor brevis) have secondary roles as hip flexors, although they are not strong hip flexors.

In the chat with my friend, I used the analogy of the spare tire on your car – it gets you there, but it’s not as good as a full tire (unless your spare is a full tire, but you know I’m referring to cars with the mini spare tire). Same deal with muscles in the body – when a muscle is doing it’s secondary job, it tends to not be as good at it. If you continue driving on the spare tire, it’s going to either seriously limit your speed, or it’s going to blow. Same goes for when a muscle is consistently asked to do it’s secondary function in addition to it’s main function.

Coach Boyle is talking about hockey and soccer athletes, where the skating stride and kicking motion both involve adduction and hip flexion, thus potentially pectineus and/or adductor brevis are being asked to work overtime.

Ultimate doesn’t have exactly the same thing, but I don’t think anyone will dispute that the cutting and pivoting we do will involve both hip flexion and adduction. So perhaps the same story.

One very interesting point Coach Boyle notes: that the two cases of sports hernias he refers to both seemed to have also involved soft tissue restrictions in the pectineus. Which is what lead to Coach Boyle coming up with that theory.

He goes on to describe what the physical therapist he was working with described as “benign neglect”, where the symptoms of an injury go away and thus the assumption is that the problem is gone. Apparently not!

Which brings us back to my point above: go see a manual therapist when you get a groin pull. But also try foam rolling it, like so:

This is also serving as a reminder that I’ve been meaning to bring in more weighted lateral squat variations for my clients who play ultimate. It’s funny how sometimes several things remind you of the same thing within a few days, even though you hadn’t considered it in a while. In addition to this discussion (and my re-reading these articles), I also saw the following excellent Eric Cressey video the other day that made me think “why aren’t we doing that at Custom Strength?” Those clients of mine who are reading this, if you’re an ultimate player, and if your hips tolerate lateral squats, you’ll be seeing these soon!

I’m not sure how many of my friends and readers are aware that I spent many, many years enduring pretty bad hip pain. I don’t want to know how much I spent in the 90s and 2000s on physio, chiro, athletic therapy, massage, acupuncture…, but let’s say it’s most likely a 5 figure number. There was also the slow transition from irregular drug use, to regular Advil (those of you who just said ‘Vitamin I‘ in your head know what I’m talking about), and then to Celebrex.

Through that time, I continued to play lots of sports and just suck up the pain. I think that’s why I get a little smirk on my face when one of my clients tells me that their (hip, knee, back, shoulder…) hurts but no they haven’t stopped playing. It’s not smart, but I get it.

It wasn’t until the mid 2000s, that I figured out how to work out properly. That’s also when I figured out that some of the exercises I had been doing, (like 350 pound partial squats) was most likely contributing to my hip problems.

That was also about the time that I got a diagnosis of femoro acetabular impingement (FAI) and a labral tear. Up until then my doctors had just called them groin strains, with no explanation for why I kept getting them.

As I learned more about how to work out properly, and got great treatments from a couple of fantastic local manual therapists, my hip bothered me much, much less. But when I played my favourite sports (skiing and ultimate), or took long car or plane rides, it felt pretty awful. Eventually I stopped doing both sports, and opted to have surgery. What a great decision that was, as I’m now 5 years out from surgery and have returned to skiing and ultimate without pain.

I’m not one to take a great outcome for granted: I worked my butt off to rehab after surgery, and I still train 2-4 times per week and include a series of “corrective exercises” for my hip. I also avoid movements that my hip doesn’t like – squats for instance. Maybe my hip would still be fine without this training, but I keep thinking back to some research that Gray Cook (creator of the Functional Movement Screen) noted about how once you’ve had an injury you’re more than 9 times more likely to have a re-injury, and to the outcome studies I had read that showed surgery for FAI had very poor results after 2 years if there was arthritis present at the time of surgery (I had “full thickness cartilage loss” in part of my joint). I would like to continue skiing into at least my 80s, which means I need to keep my hip working well.

As you can imagine, a geek like me who is also a trainer and has personal experience with a hip injury, probably has accumulated (and retained) a lot of knowledge about training around hip injuries. Indeed I have! In fact I get many client referrals for this very reason. In a few cases, I’ve helped clients avoid surgery for FAI, while in others I’ve helped get them strong before surgery and helped them return to activity post-surgery. I also train a lot of clients post-hip replacement, as the “what to do” and “what not to do” is very similar.

About 5 years ago I also started writing an ebook on the subject. I went around in circles for quite a while – at one point it got so big it was going to be the FAI bible. But then I cut out most of that because I realized simplicity is almost always better. Figure out what I have to offer that’s special, and offer it. And so I have. And I’m excited to say that “Training Around Injuries: Home Exercises for Femoro Acetabular Impingement” is written and available here. Not only is it written – it’s also filmed! There are links from the ebook to video playlists showing each of the exercises in the ebook.

With that, I’ll also be posting more blog posts about FAI, including some of the content that I cut from the ebook, but that I think you’ll still find interesting: Things like statistics about the prevalence of FAI, and theories about contributors to FAI. It’s a pretty interesting area. The only reason I cut it from the book is that it’s still something of an unknown, which means this is theoretical, and to a certain extent controversial. In my mind, it was important that the book was not controversial, but rather simply: helpful.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa with both personal and professional experience with hip disorders.

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Apparently I’m not a quick-learner, because it took me close to 20 years to learn these very basic, but oh so important things about sports injuries. During that time, I can’t count how many times I played through the pain. In my case, it was a hip injury that never seemed to heal. By the time I figured out the smart strengthening (which for a hip injury shouldn’t include the heavy squats that I was doing) and getting enough rest (if it hurts for days after you play, it’s probably not doing good things to your body), I had done too much damage to my hip joint and surgery ended up being the only option that allowed me to stay active. With the level of damage I had, surgery wasn’t a sure thing, so I have been incredibly vigilant since then. I lift weights, stretch, get manual therapy as needed, don’t play more than I should, hydrate, and warm-up before I play. I sometimes wonder if I could have avoided surgery had I figured that stuff out 10 years before I did. Who knows. The silver lining is that this experience makes me a better trainer. And it means I can share what I’ve learned over the past 25 years (20 years of pain plus 5 years pain-free) with you, in case you’re either younger or slower than me, and thus haven’t learned them yourself yet.

1. Your body isn’t like your car. If you hear a noise you don’t like while driving, you can just turn up the radio to drown it out. Problem solved. Doing that with your body, however, is a really bad idea. Ha – is anybody having a fit right now as they read that? “What?…But…You can’t…You have to maintain your car!” Okay, you’re right. That’s not the best way to treat your car. But treating your body that way is even worse. Very few of us keep the same car for our entire lives. If your [knee, hip shoulder, back, achilles...] is painful every time you [run, play ultimate, cycle, play tennis...], ignoring it and pushing through is like turning up the radio to drown out the knocking sound from your engine. Don’t do it. Go see someone. Maybe even, *gasp*, take a bit of time away from your sport.

Your body is incredibly wise, and is willing to share its wisdom with you. If you’re willing to listen. Or you can turn up the radio. I mean, there might be a good song on.

2. It’s quite amazing what you can do in the presence of injury. I say this with the caveat that you should respect your body and stay out of the pain zone. You may need to take a break from your sport for a while, but you can still get that great workout feeling, if that’s something you enjoy. If you’ve got a leg injury, you can train your other leg, your core, and your upper body. Similarly, an arm injury leads plenty of option for training your core and lower body. Back and hips are a bit more tricky because they’re pretty central, but even there – you can work around. Oh, and of course you can also incorporate “corrective exercises” into your training that can actually help speed up the recovery process. In other words, accepting an injury doesn’t mean you have to sit on your butt and get horribly out of shape. You just have to be smart about it, and you may even come away from an injury in better shape than before.

3. Just because a little is fine, doesn’t mean a lot is fine. I’m starting to sound like captain obvious now, aren’t I? And yet, I’m guessing most of you reading this either have been here, or are still here. You may be able to play your sport for a period of time without pain, but when you pound the pavement for an extra 10km, spend an extra hour in the saddle, add an extra night of ultimate, or add another 50 pounds to your squat, suddenly you’re faced with the “maybe I should turn up the radio…” situation. It turns out sometimes a little is great, and a lot is not. In those cases, is it a question that you’ve reached your body’s limit? Or maybe just the limit for your current training level? There’s no universal answer, unfortunately, but what is universally true, is that pushing through will transport you out of the world of healthy exercise and into the injury cycle. What if, you take a step back to evaluate when you hit this situation? (ducking to avoid lightning strikes). Did you increase your volume too quickly? Are you strong and fit enough to support your activity? Is there some movement issue going on that your body can tolerate for a while, but eventually doesn’t like? You may be able to figure this out on your own, or you may need some help. Or you can turn up the radio, if you’d rather pretend this isn’t actually happening. It will be more painful in the short term and long term to do that, but you won’t have to cut back on your sport this week, so that’s something.

4. You know how your mom told you you can do whatever you put your mind to? She was wrong. Or maybe she was lying, but you can sort that detail out with your shrink. The reality is, we are all built differently, and some of us aren’t built for the activity we love. For some people, it’s pretty obvious. If you’re 5’4″, you’re not going to be playing in the NBA. Sorry. Conversely, if you’re 6’7″, you’re not going to make it as a professional jockey. For others, the reality is not as clear. They might be able to do their activity of choice, but their body won’t tolerate it well. If you love to ride a bike, but you don’t have a back that tolerates flexion well, you’re not going to have a long and successful cycling career. You’ll probably retire early due to back pain. And if you’re a hockey player with an abnormal hip structure (many of us do without knowing it), then hopefully you’re not a goalie, because your hips are not going to survive the butterfly for very long. Ultimate players love to really rotate the knee back as they lunge out to throw because it allows a lower release. That’s just fine if you have the knee and hip to support that position. Unfortunately many of you don’t and are finding yourself on the sidelines with overuse injuries. Maybe it’s time to try a straight knee release. It’s true that you might lose an inch on your reach, and that might be enough to keep you off the starting line of the travelling team. That sucks. But continuing to move in your sport in a manner that your body can’t support will likely prevent you from playing at all.

If your body is continually getting injured from your sport, and you’re doing all the right things to support it (not playing too much, warming up, proper strengthening geared toward your body, seeing a good manual therapist when stuff pops up,…), then I’m sorry to be the bearer of bad news, but you might not have the body for what you’re trying to do. The good news is that you might not have to change all that much. You might just need to make some minor adjustments. Maybe a less aggressive bike set up will take away the back pain. Maybe being a stand-up goalie instead of butterfly will let you play without re-injuring your groin. Maybe keeping your knee in safer alignment will allow you to throw without re-aggravating that knee injury. It’s true that each one of these things can mean your peak performance will take a hit. But here’s the thing: if you’re unable to play because of constant injury, then your peak performance doesn’t exist. I know that sucks to hear. But it might be true. If you give an inch on peak performance, though, you may be able to get back to almost peak performance. And if you’re as awesome as you tell everyone you are, then that’s still miles ahead of everyone else.

If you are in the injury cycle but aren’t doing all the right things, then maybe it’s time to try doing them. Odds are still good that you can get out of the injury cycle without compromising performance. Awesome! But it will take work and patience. If you love your sport, then you know it’s worth it.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa, Canada, who has years of experience running, skiing, playing hockey, and playing ultimate both with and without injuries. The latter is much more enjoyable! She’s also a former hockey coach, ultimate coach, ski instructor and guide for disabled skiers.

Corrective exercises have become a popular training tool for many personal trainers in recent years, but do they work?

The corrective exercises are often found in programs in the movement preparation part of the workout, which I like to jokingly say is just a fancy way of saying the warm up. In fact it is a specific warm up, one that literally is intended to get your body prepared for movement. Some of the corrective exercises are basic stretches and activation exercises that manual therapists (I use the term manual therapist to refer to any of athletic therapist, chiropractor, massage therapist, osteopath, or physical therapist) have been using for years. Others are more integrated, born of functional training philosophies, such as the Functional Movement Screen. Continue reading Do corrective exercises work?→

If you’ve read my stuff before, then you know that I am, well, a big geek. I think I probably took fitness geek to a whole new level with my bench press assessment article, talking about the work value of a bench press based on arm span. I think this article will further raise the bar on geek in the fitness industry.

This article is about what typical problem areas I see based on the Functional Movement Screen (FMS for those who like to keep things short) assessments that I perform. Not familiar with the FMS? Check out functionalmovement.com, or read on for a brief overview. Then follow the article to see an overview of the results I’ve seen in terms of what functional movements tend to cause the most problems, and how the results are different based on gender and whether someone is an athlete.

Low back pain is a very common problem, and is a topic that comes up often when I talk with, well people. I have written a couple of articles about this in previous years, but I want to address it again, this time with a more practical approach. I realized recently that I have developed a bit of a template for clients who have low back pain, or who have a history of low back pain. The program for each person is different, but there are six exercises that I include for almost everyone who talks about their back when I first meet them. I am going to share these 6 exercises for low back health with you.

Before I begin though, I must point out the following: If daily living causes you low back pain, I strongly suggest that you look to a health care practitioner as your primary source of guidance for your back health. I won’t suggest what type of professional you see, just that someone who is a doctor, osteopath, physical therapist, chiropractor, athletic therapist, or massage therapist sees and hopefully provides some treatment for your back.

With that said, I’m going to share the 6 exercises that I have found to be most important and effective for helping people improve their low back health. Strangely I feel a need to qualify that again. I think that is because it makes me uncomfortable suggesting that I can help “cure back pain” when I am not a health care professional. I’m a trainer. And before I was a trainer, I was an engineer; not a doctor or a physical therapist. But here’s the thing: I help people’s low back pain by avoiding their back pain, not by working on it. Continue reading 6 Exercises for Low Back Health→

The title of this post is a quote from the blog article linked below. If you have a minute, please give it a read. It is a great reminder about the true value and meaning of yoga.

Yoga is such an interesting topic. There are many devout followers, but there are also detractors – many of whom are leaders in the strength and conditioning and biomechanics fields. The primary reason these professionals do not often recommend yoga is exactly because of what James MacAdam describes in his blog article titled “Confessions of a Type-A Yogi”. But if more yogis would have the same philosophical transformation about their practice that James has, I suspect most of them would become yoga-supporters.

This article was written after I had the pleasure of attending a two-day seminar with Dr. Shirley Sahrmann, author of Diagnosis and Treatment of Movement Impairment Syndromes. Throughout the course, and then on the eight hour drive home, I had a lot of opportunity to really think about what I learned and its relevance. This article presents a combination of what I learned from Dr. Sahrmann, as well as some of the thoughts it provoked.

I don’t care how much you don’t move
This was a statement she made repeatedly throughout the course, and reflects the premise that it is usually the place that moves too much that is the problem. This is in keeping with her belief of exercise instead of manual therapy as the best approach for addressing movement disorders, because manual therapy typically addresses shortness.Continue reading Lessons of the Hip & Spine from Dr. Shirley Sahrmann→